NR 509 FINAL EXAM QUESTIONS & VERIFIED
ANSWERS GRADED A LATEST EXAM
Know that in a 47-year-old man ED is usually ___________ rather than
testosterone - ANSWER-psychologic
Erectile dysfunction may be from psychogenic causes, especially if - ANSWER-
early morning erection is preserved.
it may also reflect decreased testosterone, decreased blood flow in the hypogastric
arterial system, impaired neural innervation, and diabetes
When performing a breast exam, know what abnormal masses should do when the
arm - ANSWER-may be fixed to skin or underlying tissues (may cause dimpling of
skin or retraction when arms are lifted over head or hands are pressed against hips)
Fibroadenoma and cysts mobility - ANSWER-very mobile/mobile
Know that a high proportion of breast masses are noted during ________ -
ANSWER-BSE
Breast stage 1 - ANSWER-preadolescent- elevation of nipple only
Breast stage 2 - ANSWER-breast bud stage- elevation of breast and nipple as a
small mound; enlargement of areolar diameter
breast stage 3 - ANSWER-further enlargement of elevation of breast and areola,
with no separation of their contours
,breast stage 4 - ANSWER-projection of areola and nipple to form a secondary
mound above the level of breast
breast stage 5 - ANSWER-mature stage- projection of nipple only; areola has
receded to general contour of the breast (although in some individuals the areola
continues to form a secondary mound)
Know where pain is located with pancreatitis: acute - ANSWER-epigastric, may
radiation straight to the back of other areas of the abdomen; 20% with severe
sequelae of organ failure
Know where pain is located with pancreatitis: chronic - ANSWER-epigastric,
radiating to back
Know how hepatitis A is transmitted - ANSWER-Transmitted through fecal-oral
route. Fecal shedding followed by poor handwashing contaminates water and foods
leading to infection of household and sexual contacts
Stress incontinence - ANSWER-the urethral sphincter is weakened so that transient
increases in intra-abdominal pressure raise the bladder pressure to levels that
exceed urethral resistance. Causes include childbirth and surgery, postmenopausal
atrophy of the mucosa, and urethral infection. May follow prostate surgery in men.
urge incontinence - ANSWER-detrusor contractions are stronger than normal and
overcome the normal urethral resistance. The bladder is typically small.
Mechanisms: Decreased cortical inhibition of detrusor contractions from stroke,
brain tumor, dementia, and lesions of the spinal cord above sacral level. Also
hyperexcitability of sensory pathways ie: bladder infections, tumors, and fecal
impaction. Deconditioning of voiding reflexes ie: frequent voluntary voiding at
low bladder volumes.
,overflow incontinence - ANSWER-detrusor contractions are insufficient to
overcome urethral resistance, causing urinary retention. The bladder is typically
flaccid and large, even after an effort to void. Mechanisms: obstruction of the
bladder outlet ie: BPH or tumor. Weakness of the detrusor muscle associated with
peripheral nerve disease at S2-4 level. Impaired bladder sensation that interrupts
the reflex arc ie: diabetic neuropathy.
functional incontinence - ANSWER-the patient is functionally able to reach the
toilet in time because of impaired health or environmental conditions. Mechanism:
problems in mobility resulting from weakness, arthritis, poor vision, or other
conditions. Also environmental factors such as an unfamiliar setting, distant
bathroom facilities, bed rails, or physical restraints.
Incontinence secondary to medications - ANSWER-drugs may contribute to any
type of incontinence listed. Ex: sedatives, tranquilizers, anticholinergics,
sympathetic blockers, and potent diuretics
Know where lymph nodes should be with strep - ANSWER-· Strep throat
àstreptococcal pharyngitis, bacterial infection that may cause a sore, scratchy
throat
· Common childhood infection has a classic presentation of erythema of the
posterior pharynx and palatal petechiae
· Enlarged swollen cervical lymph nodes -> superficial cervical lymph nodes
Superficial cervical -> superficial to the sternocleidomastoid
What vaccines are safe during pregnancy - ANSWER-tdap, flu, Pneumococcal,
meningococcal, Hepatitis B, rho gam
*NOT MMR, polio, or varicella
, Know what to be concerned about if you note an irregular rectal mass - ANSWER-
· Any masses with irregular borders suspicious for rectal cancer
A tender purulent reddened mass with fever or chills suggests an anal abscess.
Abscesses tunneling to the skin surface from the anus or rectum may form a
clogged or draining ano-rectal fistula. Fistulas may ooze blood, pus, or feculent
mucus. Consider anoscopy or sigmoidoscopy for better visualization.
Know what HPV Vac protects against - ANSWER-· Prevents infection from HPV
subtypes 16, 18, 6 & 11 which cause 90 % of genital warts
· The bivalent vaccine prevents infection from subtypes 16 and 18.
· Recommended for prevention of cervical, vulvar, and vaginal cancers and
precancers in females as well as anal cancer, precancers, and genital warts in both
female and males
· Vaccinated women should still get cervical cancer screening because vaccines do
not prevent all HPV subtypes
· Condoms do not eliminate the risk of cervical HPV infection
Recommended for those with compromised immune systems including HIV
Know what a 3-year-old can do in regard to jumping and balancing - ANSWER-·
Climbs well, runs easily
· Pedals a tricycle
· Walks up and down stairs, one foot on each step
Know where to place measuring tape when measuring uterus in a pregnant patient -
ANSWER-· Measure the fundal height if gestational age is >20 weeks - fundus
should reach the umbilicus
· Place tape measure on pubic symphysis and place the "zero" end of the tape
measure when you can firmly feel that bone.
ANSWERS GRADED A LATEST EXAM
Know that in a 47-year-old man ED is usually ___________ rather than
testosterone - ANSWER-psychologic
Erectile dysfunction may be from psychogenic causes, especially if - ANSWER-
early morning erection is preserved.
it may also reflect decreased testosterone, decreased blood flow in the hypogastric
arterial system, impaired neural innervation, and diabetes
When performing a breast exam, know what abnormal masses should do when the
arm - ANSWER-may be fixed to skin or underlying tissues (may cause dimpling of
skin or retraction when arms are lifted over head or hands are pressed against hips)
Fibroadenoma and cysts mobility - ANSWER-very mobile/mobile
Know that a high proportion of breast masses are noted during ________ -
ANSWER-BSE
Breast stage 1 - ANSWER-preadolescent- elevation of nipple only
Breast stage 2 - ANSWER-breast bud stage- elevation of breast and nipple as a
small mound; enlargement of areolar diameter
breast stage 3 - ANSWER-further enlargement of elevation of breast and areola,
with no separation of their contours
,breast stage 4 - ANSWER-projection of areola and nipple to form a secondary
mound above the level of breast
breast stage 5 - ANSWER-mature stage- projection of nipple only; areola has
receded to general contour of the breast (although in some individuals the areola
continues to form a secondary mound)
Know where pain is located with pancreatitis: acute - ANSWER-epigastric, may
radiation straight to the back of other areas of the abdomen; 20% with severe
sequelae of organ failure
Know where pain is located with pancreatitis: chronic - ANSWER-epigastric,
radiating to back
Know how hepatitis A is transmitted - ANSWER-Transmitted through fecal-oral
route. Fecal shedding followed by poor handwashing contaminates water and foods
leading to infection of household and sexual contacts
Stress incontinence - ANSWER-the urethral sphincter is weakened so that transient
increases in intra-abdominal pressure raise the bladder pressure to levels that
exceed urethral resistance. Causes include childbirth and surgery, postmenopausal
atrophy of the mucosa, and urethral infection. May follow prostate surgery in men.
urge incontinence - ANSWER-detrusor contractions are stronger than normal and
overcome the normal urethral resistance. The bladder is typically small.
Mechanisms: Decreased cortical inhibition of detrusor contractions from stroke,
brain tumor, dementia, and lesions of the spinal cord above sacral level. Also
hyperexcitability of sensory pathways ie: bladder infections, tumors, and fecal
impaction. Deconditioning of voiding reflexes ie: frequent voluntary voiding at
low bladder volumes.
,overflow incontinence - ANSWER-detrusor contractions are insufficient to
overcome urethral resistance, causing urinary retention. The bladder is typically
flaccid and large, even after an effort to void. Mechanisms: obstruction of the
bladder outlet ie: BPH or tumor. Weakness of the detrusor muscle associated with
peripheral nerve disease at S2-4 level. Impaired bladder sensation that interrupts
the reflex arc ie: diabetic neuropathy.
functional incontinence - ANSWER-the patient is functionally able to reach the
toilet in time because of impaired health or environmental conditions. Mechanism:
problems in mobility resulting from weakness, arthritis, poor vision, or other
conditions. Also environmental factors such as an unfamiliar setting, distant
bathroom facilities, bed rails, or physical restraints.
Incontinence secondary to medications - ANSWER-drugs may contribute to any
type of incontinence listed. Ex: sedatives, tranquilizers, anticholinergics,
sympathetic blockers, and potent diuretics
Know where lymph nodes should be with strep - ANSWER-· Strep throat
àstreptococcal pharyngitis, bacterial infection that may cause a sore, scratchy
throat
· Common childhood infection has a classic presentation of erythema of the
posterior pharynx and palatal petechiae
· Enlarged swollen cervical lymph nodes -> superficial cervical lymph nodes
Superficial cervical -> superficial to the sternocleidomastoid
What vaccines are safe during pregnancy - ANSWER-tdap, flu, Pneumococcal,
meningococcal, Hepatitis B, rho gam
*NOT MMR, polio, or varicella
, Know what to be concerned about if you note an irregular rectal mass - ANSWER-
· Any masses with irregular borders suspicious for rectal cancer
A tender purulent reddened mass with fever or chills suggests an anal abscess.
Abscesses tunneling to the skin surface from the anus or rectum may form a
clogged or draining ano-rectal fistula. Fistulas may ooze blood, pus, or feculent
mucus. Consider anoscopy or sigmoidoscopy for better visualization.
Know what HPV Vac protects against - ANSWER-· Prevents infection from HPV
subtypes 16, 18, 6 & 11 which cause 90 % of genital warts
· The bivalent vaccine prevents infection from subtypes 16 and 18.
· Recommended for prevention of cervical, vulvar, and vaginal cancers and
precancers in females as well as anal cancer, precancers, and genital warts in both
female and males
· Vaccinated women should still get cervical cancer screening because vaccines do
not prevent all HPV subtypes
· Condoms do not eliminate the risk of cervical HPV infection
Recommended for those with compromised immune systems including HIV
Know what a 3-year-old can do in regard to jumping and balancing - ANSWER-·
Climbs well, runs easily
· Pedals a tricycle
· Walks up and down stairs, one foot on each step
Know where to place measuring tape when measuring uterus in a pregnant patient -
ANSWER-· Measure the fundal height if gestational age is >20 weeks - fundus
should reach the umbilicus
· Place tape measure on pubic symphysis and place the "zero" end of the tape
measure when you can firmly feel that bone.
